Provider Demographics
NPI:1619282704
Name:BEVERWYCK, INC
Entity Type:Organization
Organization Name:BEVERWYCK, INC
Other - Org Name:EDDY VILLAGE GREEN AT BEVERWYCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-5634
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9347
Practice Address - Country:US
Practice Address - Phone:518-451-2107
Practice Address - Fax:518-482-0106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERWYCK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility